I was riding on the bus recently when my implantable cardioverter-defibrillator, (ICD), triggered and saved my life.

However, I found out that the battery was still good for less than one month. I’ve since heard that pacemakers can deteriorate near their battery renewal date but improve once a new battery is fitted. This is possible?

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It must cause you great concern. Let me explain briefly the ICD’s purpose and how it works.

This small device is placed inside the chest and used to correct irregular heart rhythms. The device is similar to the pacemaker, but has additional technology that can provide a stronger electrical shock to restart your heart.

An ICD is usually prescribed to those at higher risk for abnormally fast heart beats, such as ventricular rhythmic tachycardia. This may lead to ventricular fibrillation which is the leading cause of sudden cardiac deaths.

To restore normal heart rhythm it requires an electrical shock. This feels like a slight thump in the chest. An electrophysiologist is a skilled technician who inspects the devices every 6 to 12 months. They check for any problems with the battery, software and leads.

The device should usually be carefully reviewed every six to 12 months at your local cardiology unit by an electrophysiologist

A local electrophysiologist will review the device approximately every 6 to 12 months.

An ICD’s battery life is typically five to six years. However, this depends on the frequency of shocks that are emitted, which consume more energy than passive monitoring functions. Anecdotal reports of patients suffering from cardiac issues causing their batteries to run low may be due to this.

Patients with ICDs have received an ICD monitoring device that they can use at home since the Covid-19 pandemic. The device should be kept next to the patient’s bed. It will send data to an electrophysiologist and remotely monitor ICD function at night.

Although this is a significant advancement in heart care, it will require an internet connection.

According to what you said, this means that the device was not given or that your checkup has been completed. As this will alleviate concerns about low batteries, I recommend you talk to your doctor.

For prolapsed pelvic organs, my wife uses a pessary. It fell out last weekend and all the organs that it supported were affected. We reached out to NHS 111, 999 and were informed that there was no way of saving it. Her age is 82, and she does not wish to undergo an operation. Is there another treatment?

Peter Berriman, Angmering (W. Sussex).

Pelvic organ prolapse — where the uterus, bowel or bladder slip down into the vagina — is very common. The muscles and tissues supporting the organs are weakened by age, obesity, childbirth or other factors.

Indeed, around 50 per cent of women who have given birth naturally have some degree of prolapse of the womb — 10 to 20 per cent will have symptoms such as incontinence as a result. There are many treatment options depending on severity of symptoms and the impact they have on one’s quality of living.

The most common non-surgical treatment — the route your wife is following — is a vaginal pessary. This silicone device supports the pelvic organs by being placed inside the vagina.

Fitting the pessary will be done by a gynaecologist. Weight change and ageing can have an impact on the pessary’s fit. A follow-up appointment should be scheduled every 6-12 months to confirm this.

Without these essential reviews, patients can find themselves in a situation like your wife’s.

The second key element of non-surgical management is pelvic floor exercises that strengthen the muscles holding the organs together. These exercises can result in a significant improvement if they are taught by a qualified physiotherapist. They can also be practiced at-home.

It is never too late to start these, and your wife’s gynaecologist can arrange a referral.

When pessaries and pelvic floor exercises don’t work or a prolapse is severe, there are a number of surgical options.

You say your wife is reluctant to pursue these and I fully understand why — the operation has been associated with a recurrence rate of up to 30 per cent, and between 13 and 65 per cent of continent women develop stress urinary incontinence after the surgery.

This is why I recommend that your wife ask her GP to refer to a gynaecologist to have a reassessment done and to place a new pessary. Also, she should inquire about the possibility of pelvic floor exercises.

Her poor service by the NHS has led to her being underserved by it so far.

Be assured that help is at hand and the predicament can be resolved.